Respiratory Alkalosis

Respiratory alkalosis  (primary hypocapnia)

  • Decrease in pCO2
  • Signs/symptoms: increased rate & depth or breaths, lightheadedness, syncope, cramps, muscle spasms, confusion, decreased mental acuity, seizures, tachycardia, arrhythmias, increased episodes of angina
  • Causes:  liver or pulmonary disease, CHAMPS
    • CNS disease  (infection, trauma, tumor, CVA)
    • Hypoxia (high altitude, hypotension, CHF)
      • Hyperventilation due to the following can cause hypoxia:  Fever, prego, excessive mechanical ventilation
    • Anxiety
    • Mechanical ventilators
    • Progesterone
    • Salicylates/sepsis
  • Response:
    • Acute: intracellular buffering, HCO3- decreases 2 mEq/L [from 24] for every 10 mmHg drop in pCO2
    • Chronic:  renal adaptation (increased bicarb excretion), HCO3- decreases 5 mEq/L [from 24] for every 10 mmHg drop in pCO2
  • Treatment:
    • Remove/treat underlying cause
    • Rebreathing device (mask, paper bag)
    • Sedatives (benzos, morphine)
    • Mechanical ventilation (+ sedation/muscle paralysis)

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